title: Liver metastases in close contact to hepatic veins ablated under vascular exclusion.
abstract: BACKGROUND
  Liver metastases (LM) in close contact to hepatic veins (HV) are a frequent cause of unresectability. Reconstruction of hepatic veins is technically difficult and outcomes are poor. Intra-operative radiofrequency ablation (IRFA) with vascular exclusion (VE) may be a useful approach.
  
  
  METHODS
  Out of 358 patients operated for LM, 22 with LM close to a HV treated by IRFA under VE with at least one year of follow-up were included in this retrospective study. Technical success was evaluated at four months by CT scan of the ablated lesion. Complications; local, hepatic and extra-hepatic recurrence rates, and overall survival are reported.
  
  
  RESULTS
  The median number of metastases was 4.5 [range: 1-12]. Seventeen patients had bilateral metastases. The median size of ablated lesions was 2 cm [range: 1-5.5]. Seven complications occurred (1 Grade 1, 2 Grade 3b and 4 Grade IVa), with no mortality. No recurrence of ablated lesions was detected at four months or during follow-up. Seventeen patients had new or extra-hepatic lesions. Median overall survival for colorectal patients was 40 months 95%CI[17.5-not reached].
  
  
  CONCLUSIONS
  IRFA plus VE for LM in close contact to a HV is a novel approach, appearing to be a safe and effective technique which can extend the applications of liver metastases surgery.
authors.affiliation: Digestive Tumours Unit, Institut Bergonié, 229 cours de l'Argonne, 33076 Bordeaux Cedex, France; Université Bordeaux Segalen, 166 cours de l'Argonne, 33076 Bordeaux, France. Electronic address: s.evrard@bordeaux.unicancer.fr.
authors.forename: S
authors.initials: S
authors.lastname: Evrard
authors.forename: V
authors.initials: V
authors.lastname: Brouste
authors.forename: P
authors.initials: P
authors.lastname: McKelvie-Sebileau
authors.forename: G
authors.initials: G
authors.lastname: Desolneux
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017115:Catheter Ablation / Q000009:adverse effects; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D006503:Hepatic Veins / Q000473:pathology*; D006801:Humans; D007432:Intraoperative Period; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000473:pathology* / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D012189:Retrospective Studies; D015996:Survival Rate; D047368:Tumor Burden
keywords: Ablation techniques; Colorectal liver metastases; Complications; Hepatic vein; Mortality; Radiofrequency ablation; Vascular exclusion